超声心动图根据主动脉瓣和/或二尖瓣反流压差评估左心腔压力价值的探讨

Evaluation of left-side intracardiac pressure in patients with mitral and aortic valve regurgitation by echocardiography

目的采用血浆脑钠素(BNP)和二尖瓣血流频谱舒张早期速度与二尖瓣环组织多普勒舒张早期速度比值(E/Ea)等指标作参照,探讨超声心动图根据主动脉瓣和二尖瓣反流压差评估左心腔压力的临床实用价值。方法研究对象为118例超声心动图存在轻度二尖瓣反流和/或主动脉瓣反流患者(GTOTAL)。其中31例测定了BNP(GBNP),余87例未检测BNP(NGBNP)。常规超声心动图检查记录射血分数(EF),左心房前后径(LAD),常规检测右上肢肱动脉血压(收缩压,Ps;舒张压,Pd)、主动脉瓣反流频谱舒张末期速度(VAR)、二尖瓣反流频谱最大速度(VMR)。根据公式计算:左心室舒张末期压力(LVEDP)=Ps-4VAR2;左心房压力(LAP)=Ps-4VMR2。分析各组BNP、E/Ea、EF以及LAD与LAP和LVEDP的相关性。结果方差齐性检验和一致性检验显示各组间患者分布状态无显著差异(P>0.05)。各组LAP与BNP、E/Ea、LAD和EF均呈中度相关;各组LVEDP与BNP、E/Ea、LAD和EF的相关性差。结论利用二尖瓣反流测算LAP有一定实用价值。但利用主动脉瓣反流测算LVEDP不能客观反映患者的病理生理状态。

Objective Using brain natriuretic peptide （BNP） and the ratio of mitral velocity to early diastolic velocity of the mitral annulus （E/Ea） as reference to investigate the value of evaluating left-side intracardiac pressure in patients with mitral and aortic valve regurgitation by echocardiography, Methods 118 patients with mild mitral and/or aortic valve regurgitation （GTOTAL） were investigated. BNP were measured in 31 of 118 （GBNP）, other 87 cases did not measure BNP （NGBNP）. The ejection fraction （EF）, left atrial diameter （LAD）, the end diastolic velocity of aortic valve regurgitation （VAR）, the maximum velocity of mitral regurgitation （VMR） were measured with echocardiography. The systolic blood pressure （Ps）, diastolic blood pressure （Pd） were measured with mercurial sphygmomanometer. According below formula to calculate left ventricular end diastolic pressure （LVEDP） and left atrial pressure （LAP） ： LVEDP= Ps-4VAR^2; LAP = Ps-4VMR^2. Re suits Homogeneity test for variance and consistency checking showed there was no significance about patients distribution between GBNP and NGBNP group. In every group, there was a moderate correlation between LAP and BNP or E/Ea or LAD or EF; But there was no significant correlation between LVEDP and BNP or E/Ea or LAD or EF. Conclusion The method of measurement of left atrial pressure with mitral valve regurgitation by echocardiography can be used in practical in some extent. But measurement of left ventricular end diastolic pressure with aortic valve regurgitation by echocardiography can not reflect real pathophysilogical condition.